Epidural analgesia in Scotland: a survey of extradural opioid practice

A postal survey of all Consultant Anaesthetists working within Scotland was conducted to establish the current state of epidural analgesia and the level of post-operative care for patients after epidural opioid administration. Of those consultants using epidurals for post-operative analgesia, 89% use extradural opioids, and the lipid soluble opioids diamorphine and fentanyl by an infusion technique were the most popular. For analgesia in labour the use of extradural opioids drops to 41% with fentanyl by bolus the commonest drug and method of administration. Monitoring requirements after extradural opioids are variable with more than half of consultants satisfied with intermittent observational measurements. Sixty-nine per cent of consultants frequently send their patients to a high dependency unit following epidural opioid administration. Additional administration of opioids on an ordinary ward setting is considered inappropriate by over half of the consultants replying. There is considerable variability amongst anaesthetists as to how patients receiving epidural opioids should be monitored and National Recommendations are required to stop the present confusion.